{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:53:06Z","timestamp":1781581986592,"version":"3.54.5"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"unspecified","delay-in-days":165,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Norwegian Research Fund for General Practice"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,5,30]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Systolic murmurs are common in adults without significant valvular heart disease (VHD) and are more prevalent in women than in men, but the determinants of murmur audibility remain unclear. We aimed to identify the physiological determinants of innocent murmurs and examine the basis for sex differences in murmur prevalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional population-based study, we analysed data from 1680 participants in Troms\u00f87 without significant VHD who underwent echocardiography and heart sound recording. We used multivariable logistic regression with complete-case data from 1643 participants to identify determinants of innocent murmurs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1680 participants, 339 (20.2%) had an innocent murmur. In multivariable analysis, mean aortic valve gradient was the strongest determinant (OR 23.79 per 5 mm Hg, 95%\u2009CI 15.01 to 38.71), followed by female sex (OR 3.42, 95%\u2009CI 2.38 to 4.99), age (OR 1.41 per 10 years, 95%\u2009CI 1.22 to 1.64), systolic blood pressure (OR 1.12 per 10 mm Hg, 95%\u2009CI 1.04 to 1.20)\u2009and haemoglobin (OR 0.86 per 10\u2009g\/L, 95%\u2009CI 0.75 to 0.98). Murmur probability increased steeply with increasing gradient and exceeded 50% at 6\u20138\u2009mm Hg, depending on sex. Women had a higher murmur probability than men across the observed gradient range.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In adults without significant VHD, systolic murmurs were strongly associated with mean aortic valve gradient and occurred at lower gradients in women than in men. These findings support interpreting systolic murmurs as a probabilistic and context-dependent clinical finding rather than a binary marker of VHD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004132","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:11:18Z","timestamp":1781579478000},"page":"e004132","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of systolic murmurs without significant valvular heart disease in an unselected Norwegian adult population: the Troms\u00f8 Study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1507-1349","authenticated-orcid":false,"given":"Stian","family":"Andersen","sequence":"first","affiliation":[{"name":"General Practice Research Unit, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6759-6011","authenticated-orcid":false,"given":"Anne Herefoss","family":"Davidsen","sequence":"additional","affiliation":[{"name":"General Practice Research Unit, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Niklas","family":"Waaler","sequence":"additional","affiliation":[{"name":"Department of Medical Biology, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6519-9669","authenticated-orcid":false,"given":"Peder Andreas","family":"Halvorsen","sequence":"additional","affiliation":[{"name":"General Practice Research Unit, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9348-3149","authenticated-orcid":false,"given":"Henrik","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway"},{"name":"Department of Cardiology, Akershus University Hospital, L\u00f8renskog, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9773-3141","authenticated-orcid":false,"given":"Hasse","family":"Melbye","sequence":"additional","affiliation":[{"name":"General Practice Research Unit, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0472-7261","authenticated-orcid":false,"given":"Juan Carlos","family":"Aviles Solis","sequence":"additional","affiliation":[{"name":"General Practice Research Unit, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"2026061520100760000_13.1.e004132.1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313082"},{"key":"2026061520100760000_13.1.e004132.2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2024-325499"},{"key":"2026061520100760000_13.1.e004132.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8175.2007.00425.x"},{"key":"2026061520100760000_13.1.e004132.4","doi-asserted-by":"crossref","first-page":"101479","DOI":"10.1016\/j.cpcardiol.2022.101479","article-title":"Correlation between Murmurs and Echocardiographic Findings; 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